536163

research-article2014
CPXXXX10.1177/2167702614536163Joormann, VanderlindEmotion Regulation in Depression

Special Series

Clinical Psychological Science

Emotion Regulation in Depression: 2014, Vol. 2(4) 402421

The Author(s) 2014
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DOI: 10.1177/2167702614536163

Reduced Cognitive Control cpx.sagepub.com

Jutta Joormann and W. Michael Vanderlind

Northwestern University

Abstract
Sustained negative affect and difficulties experiencing positive affect are hallmark features of major depressive disorder.
Recent research has suggested that difficulties in emotion regulation are at the core of these cardinal symptoms of
major depressive disorder; depressed patients exhibit more frequent use of maladaptive emotion regulation and
difficulties effectively implementing adaptive strategies. It remains unclear, however, what underlies these difficulties
in emotion regulation. Cognitive theories of depression have a long tradition of focusing on cognitive factors that
increase depression risk and maintain depressive episodes, but the link between cognitive and affective aspects of
major depressive disorder remains to be explored. We propose that cognitive biases and deficits in cognitive control
putatively associated with depression affect emotion regulation in critical ways, thereby setting the stage for maintained
negative affect and diminished levels of positive affect. We close with a discussion of implications for treatment and
future directions for research in this area.

Keywords
depression, cognition, emotion, biases, emotion regulation

Received 4/2/13; Revision accepted 1/31/14

Major depressive disorder (MDD) is among the most prev-
alent and devastating of all psychiatric disorders; it affects
almost 20% of the U.S. population at some point in their
lives (Kessler & Wang, 2009). Given the high prevalence
and the substantial personal and societal costs of MDD,
efforts to identify risk factors and underlying mechanisms
as well as effective intervention strategies are particularly
pressing. MDD is defined by disordered affect, specifically
sustained negative affect, and difficulties experiencing
positive affect (American Psychiatric Association, 2013).
Theories of the onset, maintenance, and recurrence of
MDD, however, have traditionally focused on cognition
and behavior. Similarly, cognitive-behavioral interventions
have proven successful in treating MDD by focusing on
the modification of maladaptive cognitions and behaviors
(Beck, Rush, Shaw & Emery, 1979). Despite these suc-
cesses, many researchers have pointed out that a closer
look at individual differences in the experience of and
response to negative and positive affect may help to better
understand vulnerability to MDD and thereby improve
treatment approaches (Campbell-Sills & Barlow, 2007).
Indeed, an important assumption of cognitive theories of
depression remains largely untested, that is, the idea that
cognitive biases and deficits are indeed causally linked to
emotional responding.
Individual differences in responses to negative events
and, most important, in the regulation of emotion have
been linked to heightened risk for the onset of MDD
( Joormann & Siemer, 2014). Indeed, it has been proposed
that individuals who experience episodes of depression
differ from their nondepressed counterparts not so much
in their initial responses to negative events but in their
responses to the ensuing affect and, specifically, in their
ability to repair or regulate negative emotion, which
results in longer episodes of sadness and depressed mood
(Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008; Teasdale,
1988). Individual differences in the ability to regulate
Corresponding Author:
Jutta Joormann, Department of Psychology, Northwestern University,
2029 Sheridan Rd., Evanston, IL 60208
E-mail: jutta.joormann@northwestern.edu
Emotion Regulation in Depression 403
emotional responses may therefore play an important role
in understanding depression. In this article, we review
the literature on emotion regulation (ER) difficulties in
depression and then examine underlying mechanisms of
emotion dysregulation by focusing on basic cognitive
processes that may help or hinder ER. The focus is on
studies that have used clinically diagnosed samples, but
studies with analogue samples are also reviewed if they
are particularly informative or if clinical studies are miss-
ing. Our aim in this article is to identify important gaps in
knowledge and discuss future directions for research in
this area.
ER in Depression
ER is defined as strategic and automatic processes that
influence the occurrence, magnitude, duration, and
expression of an emotional response (Gross, 2014). ER is
closely related to the construct of coping (Lazarus, 1966),
even though coping usually refers to a broader construct
that entails emotion-focused as well as other strategies,
such as problem solving over larger periods of time (such
as coping with loss). Although it is not straightforward to
differentiate adaptive from maladaptive ER strategies,
previous research has identified specific strategies that
are less likely to effectively regulate affect and yet more
likely to incur additional costs, such as heightened physi-
ological arousal and cognitive demand (Gross & John,
2003; Webb, Miles, & Sheeran, 2012). Studies that have
investigated ER in depression have focused on questions
of whether depressed individuals are more prone to use
maladaptive strategies and whether depression is associ-
ated with difficulties implementing more adaptive strate-
gies ( Joormann & Siemer, 2014). Whereas many
researchers have examined the first question, mostly by
using self-reports of habitual use of ER strategies, far
fewer researchers have examined individual differences
in the effectiveness of adaptive strategy use.
Maladaptive strategy use in depression
A particularly detrimental response to negative affect that
has been associated with depression is rumination.
Rumination is defined as repetitive thinking that focuses
an individuals attention on his or her depressive symp-
toms and on the implications, causes, and meanings
of these symptoms (Nolen-Hoeksema etal., 2008). The
response-style theory proposes that rumination is a trait-
like response to negative affect (Nolen-Hoeksema, 1991)
that has been linked not only to depression but also to a
range of internalizing and even some externalizing disor-
ders. In an extensive program of correlational and exper-
imental studies, Nolen-Hoeksema and colleagues have
found that this response style exacerbates sad mood and
predicts future depressive episodes (see review by
Nolen-Hoeksema et al., 2008). Given the link between
rumination and increased negative affect, it may seem
counterintuitive to refer to rumination as an ER strategy.
However, currently depressed individuals and those at
risk for the disorder frequently ruminate when they expe-
rience negative affect or after they encounter a negative
event. Furthermore, studies have shown that depressed
individuals perceive many benefits of rumination, such as
feelings of increased self-awareness and understanding
(Papageorgiou & Wells, 2001). Lyubomirksy and Nolen-
Hoeksema (1993), for example, reported that rumination
was associated with an enhanced sense of insightfulness.
In addition, ruminative responses to negative affect fre-
quently occur as a more automatic response to experi-
encing negative affect (Hertel, 2004), but they may be
difficult to control and terminate, even if unwanted.
Considerable evidence has linked higher trait rumina-
tion with the onset and maintenance of depression (see
Nolen-Hoeksema et al., 2008, for a review). Moreover,
studies have shown that rumination mediates the gender
difference in depressive symptoms (Nolen-Hoeksema,
2000; Nolen-Hoeksema, Stice, Wade, & Bohon, 2007).
Research also has indicated that rumination enhances
cognitive biases (e.g., Lyubomirksy & Nolen-Hoeksema,
1995) and impairs recovery from acute stressors (Stewart,
Mazurka, Bond, Wynne-Edwards, & Harkness, 2013).
Rumination in these studies was usually contrasted with
distraction, another ER strategy that we discuss later. In
general, compared with distraction, rumination leads to
sustained negative mood, increased negative cognitions,
increased overgeneral autobiographical memory, and
decreased effective problem solving in depressed partici-
pants (e.g., Watkins & Moulds, 2005; Watkins, Teasdale, &
Williams, 2000). The tendency to ruminate has also been
shown to be associated with aberrant activity in the lim-
bic system, an area of the brain associated with emo-
tional responding. Specifically, a recent study has shown
that among previously depressed individuals, greater lim-
bic activity in response to negative images and less activ-
ity in response to positive images was associated with
higher levels of habitual rumination. It is interesting that
this relation was not observed among healthy individuals
(Thomas etal., 2011).
What characterizes rumination and differentiates it
from negative automatic thoughts is that it is a style
of thought rather than just negative content (Nolen-
Hoeksema, 1991; Nolen-Hoeksema et al., 2008). Thus,
rumination is defined by the process of recurring
thoughts and ideas often described as a recycling of
thoughts and not necessarily by the content of these
recurring thoughts. It is interesting, therefore, that recent
studies have also focused on rumination in response to
positive affect in depression. Dysphoric and depressed
404 Joormann, Vanderlind
individuals, for example, reported attempting to rumi-
nate on positive affect less frequently than did healthy
control participants (Werner-Seidler, Banks, Dunn, &
Moulds, 2013). In healthy individuals, rumination in the
context of positive events often takes the form of upreg-
ulating and maintaining the positive affect, and the
absence of such a response in depression may be related
to anhedonia, although this remains to be tested.
In addition, depression has been shown to be associ-
ated with a ruminative response that involves attempts to
dampen or reduce the experience of positive affect. A
self-reported dampening response to positive affect, for
example, predicted depressive symptoms in 3- and
5-month follow-up assessments in two nonclinical student
samples (Raes, Smets, Nelis, & Schoofs, 2012). Similarly,
Werner-Seidler etal. (2013) reported that dysphoria, cur-
rent MDD, and a history of depressive episodes were
each associated with increased dampening of positive
affect. In addition, this dampening response was uniquely
related to anhedonia symptoms. Neuroimaging studies
also have suggested that depression may be characterized
by attempts to dampen positive affect. For example, par-
ticipants with MDD, compared with healthy control par-
ticipants, showed greater activity in the dorsolateral
prefrontal cortex (DLPFC) in response to positive images
(Demenescu etal., 2011). Although the authors concluded
that increased activity in the DLPFC might reflect greater
demands of ER during exposure to mood-incongruent
stimuli, an alternative explanation is that increased DLPFC
activity may reflect active dampening of elicited positive
affect. However, this possibility remains to be tested and
represents an exciting area for future research.
In sum, these studies suggest that rumination in
response to negative affect as well as rumination in
response to positive affect in the form of dampening may
play an important role in depression, thereby resulting in
sustained negative mood, decreases in positive affect,
and enhanced cognitive biases. It should be kept in mind,
however, that higher trait rumination has been shown to
be associated with the onset and maintenance of other
internalizing and even some externalizing disorders, and
recent models have suggested that rumination may be
an important transdiagnostic risk factor (see Nolen-
Hoeksema et al., 2008, for a review; McEvoy, Watson,
Watkins, & Nathan, 2013). Still, a recent meta-analysis
reported that even though rumination was elevated in
mood and anxiety disorders, participants with mood dis-
orders, compared with those with anxiety disorders,
reported significantly more rumination (Olantunji,
Naragon-Gainey, & Wolitzky-Taylor, 2013).
In addition to rumination, studies on ER in depression
have investigated the use of suppression, which has
long been regarded as a particularly maladaptive regula-
tion strategy (Gross & John, 2003). Suppression is
conceptualized as an ER strategy by which an individual
attempts to inhibit the effects of external cues on internal
(e.g., physiological) and external (e.g., emotional expres-
sion) states. The inhibition of emotion expression is fre-
quently referred to as expressive suppression. Research
on emotion suppression has demonstrated that habitual
use of this strategy not only is largely ineffective in reduc-
ing negative emotions but also increases physiological
arousal and cognitive load. Findings have indicated that
expressive suppression, for example, is associated with
increased depression symptoms ( Joormann & Gotlib,
2010). Moreover, emotion suppression has been associ-
ated with increased use of rumination (Liverant, Kamholz,
Sloan, & Brown, 2011). Even though one study has
indicated that providing instructions on the use of expres-
sive suppression in response to negative stimuli may
be efficacious in reducing acute emotional responding
among depressed participants (Liverant, Brown, Barlow,
& Roemer, 2008), other studies have reported a link to
increased depressive symptoms and negative affect. For
example, in a clinical sample that included depressed
and anxious participants, Campbell-Sills, Barlow, Brown,
and Hofmann (2006) examined emotion suppression
using a mood-induction film and the assessment of spon-
taneous use of ER strategies. They reported that clinical
participants used more suppression, relative to control
participants, and that suppression was related to higher
levels of negative affect. In addition, a recent prospective
study has suggested that depression may be a precursor
of habitual use of suppression in adolescence (Larsen
etal., 2013). The findings of these studies suggested that
use of suppression not only may be related to depression
but also may again represent a transdiagnostic risk factor,
similar to rumination.
Depression may be associated with suppression of
positive emotion as well as negative emotion. Similar to
findings on dampening in depression, Beblo etal. (2012)
found that a diagnosis of MDD was associated with
increased self-reported suppression of both negative and
positive emotions, which was also related to symptom
severity. Beblo etal. discussed fear of emotion as a poten-
tial underlying mechanism, which fits nicely with a recent
finding by Werner-Seidler etal. (2013) that dysphoria was
associated with apprehension about experiencing intense
emotions. Difficulties enhancing and maintaining posi-
tive emotion in addition to active dampening of positive
affect may help explain anhedonia symptoms in MDD.
Use and implementation of adaptive
strategies in depression
In addition to the more frequent use of maladaptive strate-
gies, depression may be characterized by decreased use
Emotion Regulation in Depression 405
of and difficulties implementing more adaptive strategies,
such as reappraisal. The tendency to interpret emotion-
eliciting situations in a negative way is a defining feature
of depressive disorders (Beck, 1967). Altering these inter-
pretations is a powerful way to regulate affect and a
main component of cognitive therapy for depression.
Reappraisal involves changing a situations meaning to
alter ones emotional response to the situation (Gross,
1998; Gross & John, 2003). Reappraisal has been studied
extensively in nonclinical populations and has been
shown to reduce negative affect ( John & Gross, 2004;
Urry, 2009). In addition, reappraisal does not entail the
social and cognitive costs associated with rumination and
other less adaptive strategies (Richards & Gross, 2000).
Furthermore, reappraisal has been associated with
reduced physiological activation in response to negative
emotion (Ray, McRae, Ochsner, & Gross, 2010; Urry, 2009).
It is not surprising that in studies of clinical and non-
clinical samples, researchers have tied less frequent
habitual use of reappraisal to greater depression severity
(Garnefski & Kraaij, 2006; Joormann & Gotlib, 2010). It
should be noted, however, that most of these studies
have used a cross-sectional design, which makes it diffi-
cult to examine whether decreased reappraisal use is a
symptom of depression or, indeed, a risk factor. Reduced
use of reappraisal, for example, was reported in a clinical
sample diagnosed with depression and anxiety (Garnefski,
Legerstee, Kraaij, van den Kommer, & Teerds, 2002). It is
interesting that in a recent meta-analysis, Aldao, Nolen-
Hoeksema, and Schweizer (2010) reported that whereas
greater reappraisal use was related to lower depression
and anxiety symptoms, reappraisal was more inconsis-
tently related to symptoms than were other strategies
(rumination, suppression). In a follow-up study, Aldao
and Nolen-Hoeksema (2012) found that the degree to
which reappraisal is adaptive depends on the frequency
of maladaptive strategy use; reappraisal was related to
lower depression symptoms but only for individuals who
frequently use maladaptive strategies (rumination, sup-
pression, etc.). The authors argued that reappraisal serves
as a compensatory strategy to counteract the problems
that come with greater maladaptive strategy use. These
findings are particularly noteworthy, given that they sug-
gest that focusing on the habitual use of one specific
strategy is limited. Instead, it may be critical to examine
the relation between use of adaptive and maladaptive
strategies and psychopathology.
Studies with clinical samples that investigate the use of
a range of different ER strategies may therefore be particu-
larly informative. In a recent study, for example, DAvanzato,
Joormann, Siemer, and Gotlib (2013) compared a diag-
nosed depressed sample of individuals with participants
diagnosed with social anxiety disorder and healthy control
individuals in their habitual use of different ER strategies.
Compared with control participants, depressed partici-
pants were more likely to ruminate and less likely to use
reappraisal, whereas participants with social anxiety disor-
der reported more expressive suppression compared with
both groups. In addition, although elevated rumination
was found in previously depressed participants who were
not currently depressed, healthy control participants and
the previously depressed group did not differ on use of
reappraisal or expressive suppression. It is notable that
use of reappraisal and rumination were related to symp-
tom severity across all samples, whereas expressive sup-
pression use was unrelated to depressive or anxiety
symptoms.
These results are consistent with findings from a study
by Ehring, Tuschen-Caffier, Schnlle, Fischer, and Gross
(2010) in which they compared formerly depressed
participants with never-depressed participants. Like
DAvanzato etal. (2013), Ehring etal. reported that for-
merly depressed participants showed more rumination
but did not differ from never-depressed participants in
their reported use of reappraisal or suppression. In addi-
tion, the formerly depressed group reported more emo-
tion nonacceptance. This result fits nicely with the
previously mentioned findings by Werner-Seidler et al.
(2013) and Beblo etal. (2012) that depression is associ-
ated with fear of emotion and apprehension about expe-
riencing intense emotion. It is interesting that even
though the groups did not differ on habitual use of sup-
pression, the formerly depressed group reported more
spontaneous use of suppression in response to a nega-
tive film clip. No group differences were found in reap-
praisal use in response to the film clip. Ehring et al.
interpreted this finding by suggesting that depression
may not be associated with suppression of all emotional
experiences but, rather, with the specific suppression of
sadness. Further studies are needed to examine this pos-
sibility more closely.
In addition to investigating the relation between habit-
ual reappraisal use and depression, studies have focused
on whether reappraisal is actually less effective in clinical
populations. These studies typically instruct participants
to use a strategy such as reappraisal during an emotion-
eliciting event and then assess affect before and after the
use of the strategy, as well as psychophysiological indica-
tors of arousal during strategy use. Only a handful of
studies have investigated the effectiveness of reappraisal
in depression, and results are mixed. Moreover, to our
knowledge, only one study has focused on whether cur-
rent MDD is associated with less effective reappraisal
use. In a nonclinical sample of individuals who had
recently experienced a stressful life event, for example,
elevated depression symptoms were related to less effec-
tive reappraisal in response to an emotion-eliciting film
clip (Troy, Wilhelm, Shallcross & Mauss, 2010). Similarly,
406 Joormann, Vanderlind
individuals lower in well-being (composite of lower posi-
tive affect, higher negative affect, and lower life satisfac-
tion) exhibited reduced effectiveness of reappraisal to
negative emotional pictures, and performance on this
task was related to reduced habitual use of reappraisal
(McRae, Jacobs, Ray, John & Gross, 2012).
In contrast, Ehring et al. (2010) reported that even
though formerly depressed participants were less likely
to endorse the use of reappraisal using self-report, they
did not differ from the control group in their ability to
effectively use reappraisal when explicitly instructed to
do so. Indeed, these authors summarized their results by
saying that formerly depressed participants choose inef-
fective strategies but can use more functional strategies if
so instructed. Finally, Ellis, Vanderlind, and Beevers
(2012) assigned currently depressed and healthy individ-
uals to one of three ER strategiesreappraisal, accep-
tance, or no instructionand had them complete an
anger-eliciting task. The authors found that, in compari-
son with individuals assigned to the acceptance condi-
tion, participants in the reappraisal condition reported
less change in anger across the frustrating task. However,
participants in the reappraisal condition did not differ
from those assigned to the no-instruction condition, and
the authors did not observe an ER strategy by diagnostic
group interaction. This preliminary evidence suggests
that MDD individuals are as able as healthy control indi-
viduals to reappraise when they experience anger.
However, future research is needed to explore whether
these findings extend to sadness.
Neuroimaging studies on the use of reappraisal during
emotional-information processing have suggested that
depression is associated with less effective use of reap-
praisal. Brain regions associated with cognitive control
over emotions (e.g., DLPFC) have also been linked to the
instructed use of reappraisal, and Johnstone, van Reekum,
Urry, Kalin, and Davidson (2007) found that nonde-
pressed individuals, but not their depressed counterparts,
displayed both increased DLPFC activation and decreased
amygdala activation when they reappraised emotional
pictures. This pattern suggests depression-related diffi-
culties in recruiting brain regions involved in the cogni-
tive control of emotions during instructed reappraisal.
Furthermore, there is evidence that difficulty reappraising
is not solely a symptom of depression. In a recent study,
for example, previously depressed and healthy partici-
pants were instructed to reappraise during exposure to
emotional images (Kanske, Heissler, Schnfelder, &
Wessa, 2012). The results showed a deficit in the down-
regulation of amygdala responding to negative stimuli in
the remitted group and an interesting relation between
the capacity to downregulate and habitual reappraisal
use as assessed by self-report (see also Drabant, McRae,
Manuck, Hariri, & Gross, 2009). Kanske et al. (2012)
reported no group difference in initial amygdala response
to the emotional pictures, which suggests that only the
downregulation of amygdala activity is affected by a
history of depression (see also Sheline et al., 2001).
Depression-related difficulties in reappraisal, however,
may be restricted to severely depressed individuals
(Dillon & Pizzagalli, 2013).
Another strategy that is generally regarded as adaptive
is distraction. Distraction is frequently used as a control
condition in rumination studies, and many studies have
shown that distraction seems to regulate affect effectively
in depressed participants (see Nolen-Hoeksema et al.,
2008, for a review). Whereas depressed participants
instructed to ruminate show increased negative affect
and recall of negative memories, depressed participants
instructed to distract do not differ from the control group
on these measures. For example, in a study on mood
repair in depression, Joormann, Siemer, and Gotlib (2007)
induced currently, formerly, and never-depressed partici-
pants into a sad mood and then instructed them to use
distraction. The authors found that currently and formerly
depressed participants did not differ from control partici-
pants in their affect recovery, thereby suggesting that
depressed participants are able to use distraction to
effectively regulate negative affect. However, even though
distraction may be an effective strategy, depressed and
dysphoric individuals may be less likely to use it.
Lyubomirsky and Nolen-Hoeksema (1993), for example,
reported that dysphoric participants induced to ruminate
reported less willingness to engage in pleasant, distract-
ing activities. Indeed, the authors suggested that
dysphoric participants may avoid distraction because it
may interfere with their efforts to gain insight into their
problems.
Previous studies also have focused on the recall of
mood-incongruent, usually positive, material in depres-
sion ( Joormann, Siemer, & Gotlib, 2007). In these studies,
participants did not receive explicit instructions to regu-
late affect. Instead, they were informed that the project
was investigating memory processes and were asked to
recall mood-incongruent memories (i.e., recall of a posi-
tive autobiographical memory immediately after a nega-
tive-mood induction). Recall of mood-incongruent
memories was compared with a distraction condition.
Results showed that, relative to control participants, dys-
phoric as well as currently depressed and formerly
depressed participants did not experience a recovery in
their negative affect when they recalled mood-incongru-
ent memories ( Joormann, Siemer, & Gotlib, 2007; see
also Werner-Seidler & Moulds, 2012). Distraction, how-
ever, repaired negative affect in all groups. Moreover,
recent functional MRI findings have shown that risk for
depression is characterized by difficulties using mood-
incongruent recall in the service of mood repair. For
Emotion Regulation in Depression 407
example, Joormann, Cooney, Henry, and Gotlib (2012)
found that girls at high risk for depression, as a result of
their mothers history of depressive episodes, but free of
any current or past psychopathology showed, relative to
their low-risk counterparts, increased amygdala respond-
ing to a mood induction and failure to downregulate this
activation using positive-memory recall. Altogether, these
results suggest that depression and risk for the disorder
are associated with an inability to focus on positive mate-
rial to offset negative affect, which may be an important
automatic mood-repair mechanism and, thus, make one
more vulnerable for developing the disorder.
These results mirror findings that have shown that
depression is associated with difficulties in the process-
ing of positive material and in the use of positive material
to offset negative affect. When instructed to enhance and
maintain positive affect, for example, MDD individuals
exhibited difficulty sustaining nucleus accumbens activa-
tion over time (Heller etal., 2009). Furthermore, this dif-
ficulty was related to individual differences in self-reported
positive affect. Heller etal. (2009) interpreted these find-
ings as showing that depressed participants have difficul-
ties sustaining engagement of brain areas involved in
positive affect and reward over time.
In sum, the results show that depression is characterized
by increased use of rumination and less use of reappraisal.
There is some indication that rumination use may be a
stable feature of depression risk, evident even outside of
acute episodes of the disorder, whereas reduced use of
reappraisal may be observed only in people who are cur-
rently depressed (see DAvanzato etal., 2013; Ehring etal., cognitive control impair the ability to reinterpret the situ-
2010). In addition, findings are mixed when it comes to the
question whether depressed people differ from their non-
depressed counterparts in their ability to reappraise; more
research clearly is needed to clarify this pattern of findings.
Results for expressive suppression and other forms of sup-
pression are also less clear-cut and should be a focus in
future studies. It is interesting, however, that recent studies
have suggested that emotion nonacceptance and fear of
intense emotion may characterize depression (Beblo et al.,
2012; Werner-Seidler et al., 2013). In addition, preliminary
evidence has suggested that depressed individuals show
maladaptive responses to positive affect and exhibit diffi-
culties in using positive material to regulate emotions.
Indeed, depression has been associated with rumination
not only in response to negative events but also in the form
of dampening when encountering positive affect. In addi-
tion, depression has been associated with difficulties using
positive autobiographical memories to repair negative
mood. Examination of positive-affect regulation in depres-
sion represents a very exciting area of future research.
However, it is not clear what underlies the preference
and dispositional use of specific ER strategies in depres-
sion. It is likely that difficulties implementing certain
strategies also shape the selection of ER strategies. It
therefore seems important to try to identify processes
that may underlie difficulties in ER. Why do depressed
people use maladaptive strategies, and why do they find
it difficult to use adaptive strategies? Cognitive theories of
emotional disorders have identified mood-congruent
biases in the processing of emotional information, and
recent research has focused on deficits in cognitive con-
trol that may interfere with ER ( Joormann, 2010). These
studies may improve insight into mechanisms that under-
lie difficulties in ER and mood regulation and thereby
provide critical information for interventions.
Cognitive Processes and ER in
Depression
Cognition plays a critical role in human emotion.
According to cognitive theories of emotion, cognitive
appraisals of emotion-eliciting situations determine if an
emotion is experienced and which emotion is experi-
enced (Lazarus & Folkman, 1984). Cognition, therefore, is
also a primary route through which emotions are regu-
lated. Consequently, individual differences in attention,
memory, interpretation, and cognitive control may affect
peoples ability to regulate affect, thereby providing the
basis for an increased vulnerability to depression and
other psychological disorders ( Joormann, Yoon, &
Siemer, 2010). Specifically, it is proposed that depression
is associated with mood-congruent attention, memory,
and interpretation biases. At the same time, deficits in
ation in a more adaptive way, which interferes with the
use of adaptive strategies (e.g., reappraisal) and sets the
stage for increased use of maladaptive strategies (e.g.,
rumination; see Fig. 1 for a schematic illustration of cog-
nitive processes and emotion dysregulation in depres-
sion). The next sections provide a review of evidence
that documents biased cognition and diminished cogni-
tive control associated with MDD. In addition, we high-
light studies that link these biases and deficits to
difficulties in ER.
Perception and attention
Individual differences in early perception of emotional
material and in the tendency to orient toward these stim-
uli, as well as a persons ability to disengage from emo-
tional stimuli, are important factors that may influence ER
when confronted with an emotion-eliciting situation. The
question whether depression is associated with enhanced
and maybe even automatic perception of emotional stim-
uli has been investigated in studies using either sublimi-
nal material, material with low degrees of emotional
intensity, or very fast presentation times. Researchers
408 Joormann, Vanderlind
Event
Attention Bias:
Attention
Disengagement
Interpretation and Appraisal
Memory Bias
Emotional Response
Emotion Regulation
Rumination
Cognitive Control
Deficits
Reappraisal
Distraction
Fig. 1. Schematic illustration of cognitive processes and emotion dys-
regulation in depression. Cognitive biases, such as difficulties disengag-
ing from negative material and biases in interpretation and memory,
affect attention to emotion-eliciting aspects of events as well as the
appraisals of the event, which, in turn, affect the emotion response.
Through their effect on attention and appraisal processes, cognitive
biases also interfere with emotion regulation. In addition, cognitive
control deficits further impair the effective implementation of emo-
tion-regulation strategies, such as reappraisal, distraction, and mood-
incongruent recall, thereby increasing the likelihood of maladaptive
responding, for example, in the form of rumination.
have used disorder-specific material or material that is
relevant to emotion across disorders, such as facial
expressions of emotion. It is striking that few studies to
date have demonstrated biases in clinically depressed
participants when depression-relevant (or other) stimuli
have been masked to investigate unconscious processing
(see Mathews & MacLeod, 2005; Teachman, Joormann,
Steinman, & Gotlib, 2012, for reviews).
The evidence for attention biases in depression is
also mixed. In the emotional Stroop task, individuals
with depression should take longer to respond to the
color of the negative words compared with the neutral
words, thereby suggesting that their attention was
grabbed by the content of the words. Yet studies have
shown that whereas anxious participants exhibited
slower color naming of all negative words at both sub-
liminal and supraliminal exposure durations, depressed
participants did not differ from control participants in
the subliminal condition (Lim & Kim, 2005; Mogg,
Bradley, Williams, & Mathews, 1993). Several investiga-
tors have used the dot-probe task with briefly presented
and masked emotional words to investigate automatic
processing biases in depression. In the dot-probe task,
a pair of stimuli (words or faces) is presented simultane-
ously: one stimulus is neutral and the other is emo-
tional. Participants are asked to respond to a probe that
replaces the neutral or the emotional stimulus. Allocation
of attention to the spatial position of the stimuli is deter-
mined from response latencies to the probes. Here, too,
the results have not been encouraging when words
were presented briefly and masked (e.g., Donaldson,
Lam, & Mathews, 2007; Mogg etal., 1993).
Taken together, empirical findings that depression
is associated with the easy identification of mood-
congruent material or a fast orienting toward negative
stimuli are rather mixed. In contrast, many studies have
shown the presence of such biases in anxiety and other
emotional disorders (Mathews & MacLeod, 2005). There
is evidence, however, that depressed persons are charac-
terized by attentional biases in later stages of processing.
Researchers using the dot-probe task, for example, have
reported selective attention in depression but only under
conditions of long stimuli exposures (e.g., Bradley,
Mogg, & Lee, 1997; Donaldson etal., 2007; Joormann &
Gotlib, 2007). Evidence for these biases has also been
found in remitted depressed adults and high-risk off-
spring ( Joormann & Gotlib, 2007; Joormann, Talbot, &
Gotlib, 2007), which suggests that these attentional
biases are not simply a symptom of depression or a scar
of a previous depressive episode but may play an impor-
tant role in the vulnerability to depression.
Whereas the dot-probe task has been criticized as a
measure of disengagement, similar difficulties in disen-
gaging attention from negative material have now been
demonstrated in various attention tasks (Koster, De Raedt,
Goeleven, Franck, & Crombez, 2005; Rinck & Becker,
2005). In addition, eye-tracking studies have shown
that depressed participants do not necessarily exhibit
increased attentional engagement with negative stimuli
but do have difficulties disengaging their attention from
negative material (Caseras, Garner, Bradley, & Mogg,
2007; Eizenman et al., 2003; Sanchez, Vazquez, Marker,
LeMoult, & Joormann, 2013). Furthermore, there is evi-
dence that depressed individuals spend less time attend-
ing to positive material. For example, Sears, Newman,
Ference, and Thomas (2011) reported that dysphoric
and previously depressed participants, compared with
never-depressed individuals, spent less time attending
to positive images. Similar results have been observed
when clinical samples were compared with healthy con-
trol participants (Kellough, Beevers, Ellis, & Wells, 2008).
A link among cognitive biases and emotional respond-
ing has been reported in studies focused on whether
individual differences in attention biases are associated
with emotional reactivity to a stressor or mood induction.
Emotion Regulation in Depression 409
Compton, Heller, Banich, Palmieri, and Miller (2000), for
example, demonstrated that a reduced ability to disen-
gage attention was associated with increased reactivity to
a distressing film clip. Individual differences in orienting,
however, were not related to the mood response. Beevers
and Carver (2003) demonstrated that changes in atten-
tional bias for negative words but not for positive words
in response to a negative mood induction interacted with
life stress to predict onset of depressive symptoms in col-
lege students. In a recent study on attentional bias in
depression, Sanchez etal. (2013) found that attentional-
disengagement difficulties were not only characteristic of
MDD but also related to individual differences in mood
changes in response to a stress task, a finding that sug-
gests a close link between attention disengagement and
emotion reactivity. Likewise, Clasen, Wells, Ellis, and
Beevers (2013) reported that attention biases to sad stim-
uli were associated with greater impairments in mood
recovery in MDD participants.
Whereas the previous studies reported associa-
tions between individual differences in cognitive biases
and emotional responses to stressors, Ellenbogen,
Schwartzman, Stewart, and Walker (2002) examined
more directly whether attentional deployment while
exposed to a stressor predicts emotional responding.
These authors found that people under a negative stress
induction were faster to shift attention away from nega-
tive words compared with positive and neutral words
and that these attentional shifts were associated with
mood changes in response to the stressor. Ellenbogen
etal. reported further that people with elevated depres-
sion scores had difficulties shifting attention away from
emotional stimuli. Likewise, Johnson (2009) demon-
strated that participants who switched faster to the emo-
tional material were more frustrated by a stressful task.
Johnson also found that participants who were better
able to focus on happy faces and to avoid angry faces
in a dot-probe task were less frustrated and worked
harder in a stressful anagram task.
Whereas these studies suggest that attention biases are
associated with emotional responding, a more direct
proof for the causal role of cognitive biases in emotion
generation and ER would require evidence that changes
in cognitive processes are related to changes in emo-
tional states. The only set of studies that have provided
this more direct test comes from recent work on cogni-
tive-bias modification. These studies aim to retrain peo-
ples cognitive processing, which, in theory, should
enable them to more effectively respond to emotion-elic-
iting situations. It is important to note that these studies
use control groups that do not undergo the training,
which allows the researchers to conclude that the train-
ing leads to the changes in emotional responding in the
experimental group compared with the control group. In
a typical training paradigm, the dot probe is presented
more consistently after the nonthreat relevant stimuli
(rather than equally after threat and nonthreat stimuli) so
that participants learn to attend to neutral stimuli and
away from threat stimuli. These studies have demon-
strated that training highly anxious people to disengage
their attention from threat material leads to changes in
mood and reduced reactivity to stressful events. MacLeod,
Rutherford, Campbell, Ebsworthy, and Holker (2002), for
example, first established that attentional biases could be
modified by working with participants who scored in the
middle third of the distribution on the State-Trait Anxiety
Inventory (Spielberger, Gorsuch, & Lushene, 1970). They
found that after attentional training away from threat,
participants reported reduced negative affect to a stan-
dardized stress manipulation. They also demonstrated
that the changes in emotional responding were mediated
by the training-induced changes in biases.
A more recent study of attentional-bias training
extended the findings of MacLeod et al. (2002) by
showing that positive attentional biases can be trained
(Wadlinger & Isaacowitz, 2008). Participants who had
been trained to attend to positive stimuli subsequently
looked less at negative images during a stress induction
(Wadlinger & Isaacowitz, 2008). So far, most of these
studies have been conducted with samples of patients
with anxiety disorders, but at least two recent studies
have provided encouraging data that a training aimed at
modifying attention biases may also apply to depression
(Baert, Koster, & De Raedt, 2011; Wells & Beevers, 2010).
No studies thus far, however, have investigated whether
modifying cognitive biases in depressed participants
leads to changes in the use or effectiveness of ER strate-
gies and, thus, to changes in emotional responding. This
clearly presents an important direction for future research.
What are the implications of these depression-related
biases in perception and attention for ER? Depression
does not seem to be characterized by high sensitivity
toward the detection of emotion-eliciting stimuli. Instead,
depression is mostly associated with difficulties in atten-
tional disengagement. Difficulties disengaging from neg-
ative stimuli may preclude depressed people from using
effective ER strategies, such as distraction, when con-
fronted with stressful events and may result in the sus-
tained processing of emotion-eliciting stimuli and lead to
prolonged negative affect. In addition, attentional biases
toward negative material may interfere with a persons
ability to successfully reframe emotion-eliciting events.
Being stuck in attending to negative aspects of the situ-
ation may make it more difficult to shift attention to more
positive aspects, thus hindering a more balanced appraisal
of the emotion-eliciting event. Consistent with this idea is
Koster, De Lissnyder, Derakshan and De Raedts (2011)
proposition that rumination may underlie the relation
410 Joormann, Vanderlind
between attentional disengagement and emotional
responding. The authors suggested that an inability to
disengage attention from mood-congruent stimuli may
facilitate prolonged processing of such material (i.e.,
rumination), thereby hindering the use of an adaptive ER
strategy. Depressed individuals also show attentional
biases away from positive material. Attentional avoidance
of positive material may underlie difficulties upregulating
positive affect or using positive material to regulate nega-
tive affect. However, these questions have yet to be
examined empirically.
Interpretation
Most situations that evoke emotions are ambiguous. How
cues in these situations are initially interpreted and
appraised determines the emotional response and deter-
mines whether this response is appropriate in this situa-
tion or not. Reinterpretation or reappraisal is a potent ER
strategy because it allows flexible emotional responding
without changing the situation and without ignoring
the emotion-eliciting cues. Biases in interpretation, espe-
cially if they are automatic, can make it difficult to
use reappraisal and can lead to inflexible and inappropri-
ate responding (Siemer & Reisenzein, 2007). Negative-
interpretation biases could result in rigid, automatic
mood-congruent interpretations of potentially emotion-
eliciting events and may make it difficult to see the situa-
tion from a different perspective or to entertain alternative
interpretations.
Results, however, are mixed with regard to whether
depression is characterized by automatic interpretation
biases (Lawson, MacLeod, & Hammond, 2002). Butler and
Mathews (1983), for example, presented clinically
depressed participants with ambiguous scenarios and
found that, compared with nondepressed participants,
depressed individuals ranked negative interpretations
higher than they did other possible interpretations. In a
study in which researchers assessed biases by using
response latencies to target words that were presented
after ambiguous sentences, no interpretation bias was
found (Lawson & MacLeod, 1999; see also Bisson & Sears,
2007). Lawson et al. (2002) examined startle magnitude
during imagery elicited by emotionally ambiguous text.
Using this measure, these authors reported evidence for
more negative interpretations in their depressed sample
and concluded that the failure to find a bias in previous
studies was due to the use of response latencies. Cowden
Hindash and Amir (2012), however, found evidence for a
negative-interpretation bias in dysphoric individuals as
indexed by faster response times to endorse an associa-
tion between negative words and ambiguous sentences.
The authors suggested that their use of self-referent mate-
rial, as opposed to other-referent material, may explain
the previous null findings in studies that used response
time paradigms. Furthermore, a recent study reported a
negative-interpretation bias in never-disordered daughters
of depressed mothers, thereby providing evidence for a
role of these biases in increasing risk for depression onset
(Dearing & Gotlib, 2009). Thus, even though some studies
have reported negative findings, there is evidence for
biased interpretation in depression.
Researchers recently have begun to modify interpre-
tive biases in the hopes of modifying emotional respond-
ing. Mathews and Mackintosh (2000) used ambiguous
scenarios to train individuals to make either positive
(nonanxious) or negative (anxious) interpretations of
ambiguous text in a sample of anxious individuals. The
authors compared state-anxiety levels prior to and after
the training and reported that participants in the nega-
tive-training condition displayed elevated levels of anxi-
ety, whereas those in the positive-training condition
demonstrated decreased symptoms of anxiety. These
findings support the hypothesis that interpretive biases
play a causal role in anxiety levels. Yiend, Mackintosh,
and Mathews (2005) demonstrated that the effects of
interpretive training on anxiety were still present after a
24-hr delay between the training and a subsequent test.
In a related study, participants who received interpretive
training using ambiguous homophones were subse-
quently presented four distressing television clips of
real-life emergency rescue situations (Wilson, MacLeod,
Mathews, & Rutherford, 2006). Participants who were
trained to interpret ambiguity in a nonthreatening man-
ner had an attenuated anxiety reaction to the subsequent
video stressor (see also Mackintosh, Mathews, Yiend,
Ridgeway, & Cook, 2006). Furthermore, Beard and Amir
(2008) reported that changes in negative emotion were
mediated by training-induced changes in negative inter-
pretive style. These results suggest that changes in inter-
pretation biases can indeed lead to changes in emotional
responding. In one of the first studies to investigate
interpretation-bias training in depression, A. D. Williams,
Blackwell, Mackenzie, Holmes, and Andrews (2013)
showed that this training resulted in reduction of depres-
sive symptoms and that the symptom reduction was par-
tially mediated by the changes in interpretation bias.
Unfortunately, no studies so far have investigated
whether changes in interpretive biases in these training
studies lead to changes in emotional responding by
affecting peoples ability to use reappraisal when con-
fronted with emotion-eliciting situations. Thus, these
studies show that interpretive biases can lead to changes
in emotional responding but do not show that changes in
the use or effectiveness of reappraisal is the mechanism
underlying this change. In addition, previous studies
have focused primarily on anxiety, and no studies so far
have investigated whether modifying interpretive biases
Emotion Regulation in Depression 411
in depression affects emotional responding. To summa-
rize, the described studies suggest that depression is
characterized by biases in interpretation. Studies that
directly link interpretive biases to difficulties in ER are an
important area for future research.
Memory
Memories affect emotion in important ways. Recent stud-
ies have demonstrated that memories of unpleasant
events, compared with pleasant events, fade faster and
that this differential fading is associated with happiness
(Walker, Skowronski, Gibbons, Vogl, & Thompson, 2003);
that recalling positive autobiographical memories can
repair an induced negative-mood state ( Joormann &
Siemer, 2004); and that remembering positive events and
forgetting negative events is associated with increased
well-being over the life span (Charles, Mather, &
Carstensen, 2003). Indeed, mood-incongruent recall is
often used as a mood-repair strategy in response to a
negative-mood induction (e.g. Rusting & DeHart, 2000).
Memory biases, such as increased accessibility of nega-
tive autobiographical material, may lead to difficulties in
accessing mood-incongruent material, which may inter-
fere with the selection and use of effective ER strategies.
Memory biases may also determine peoples perception
of a specific situation, change their appraisals, and guide
their attention toward specific aspects of that situation. It
is not surprising that preferential recall of negative mate-
rial compared with positive material is one of the most
robust findings in the depression literature (Mathews &
MacLeod, 2005; Matt, Vazquez, & Campbell, 1992).
Depression has been associated with not only
enhanced recall of negative events but also the recall of
rather generic memories despite instructions to recall
specific events (i.e., overgeneral memory; see J. M. G.
Williams et al., 2007, for a review). Furthermore, the
extent to which an individual retrieves overgeneral mem-
ories predicted delayed recovery from affective disorders
(e.g., Dalgleish, Spinks, Yiend, & Kuyken, 2001). In addi-
tion, studies have shown that rumination may maintain
overgeneral memory in depressed patients (Watkins &
Teasdale, 2001, 2004). Understanding overgeneral mem-
ory in the context of ER in depression may therefore be
an important goal for future research. One particularly
promising study demonstrated that training dysphoric
individuals to be more concrete and less overgeneral in
their thinking led to a significant reduction in depressive
symptoms and rumination (Watkins, Baeyens, & Read,
2009; see, however, Mogoas e, Brailean, & David, 2013,
who reported no effect of concreteness training on
rumination or depression).
In sum, memory biases are important to consider
in depression. Depression has been associated with
increased accessibility of negative material and overgen-
eral memories. In addition, mood-congruent recall and
reduced accessibility of mood-incongruent material may
contribute to difficulties using ER strategies, such as reap-
praisal, but studies on this association are still needed.
Cognitive control
Overriding prepotent responses and inhibiting the pro-
cessing of irrelevant material that captures attention are
core abilities that allow individuals to respond flexibly
and to adjust behavior and emotional responses to chang-
ing situations. Cognitive control is related to the function-
ing of executive-control processes, such as inhibition,
disengagement, and updating in working memory
(Hasher, Zacks, & May, 1999; Miyake & Friedman, 2012).
Working memory is a limited-capacity system that pro-
vides temporary access to a select set of representations
in the service of current cognitive processes (Cowan,
1999; Miyake & Shah, 1999). Thus, working memory
reflects the focus of attention and the temporary activa-
tion of representations that are the contents of aware-
ness. Given the capacity limitation of this system, it is
important that the contents of working memory be
updated efficiently, which is a task controlled by execu-
tive processes (e.g., Friedman & Miyake, 2004; Hasher
et al., 1999). Executive processes must selectively gate
access to working memory, shielding it from intrusion
from irrelevant material, as well as discard information
that is no longer relevant. In this context, individual dif-
ferences in the experience and resolution of interference
are likely to affect cognitive and emotional functioning.
The occurrence of intrusive thoughts might be one
consequence of poor interference resolution. Several
researchers have suggested that rumination and depres-
sion are associated with deficits in executive functioning
(Hertel, 1997; Joormann, 2005; Whitmer & Gotlib, 2012).
Deficits in controlling the contents of working mem-
ory may affect ER because the experience of a mood
state or an emotion is generally associated with the acti-
vation of mood-congruent representations in working
memory (Siemer, 2005). In addition, effective reappraisal
may depend on a persons ability to override (automatic)
attention and interpretation biases that lead to unwanted
appraisals of the emotion-eliciting cues. The replacement
of automatic appraisals with alternative evaluations of the
situation requires cognitive control. The ability to control
the contents of working memory might therefore play an
important role in ER. Thus, an inability to appropriately
expel mood-congruent items from working memory, as
they become irrelevant, would lead to difficulties attend-
ing to and processing new information and might result
in rumination and the use of other maladaptive ER strate-
gies. Difficulties inhibiting salient but irrelevant thoughts
412 Joormann, Vanderlind
and memories would also discourage the use of more
effective ER strategies, such as reappraisal.
There is emerging evidence that depression is charac-
terized by deficits in the inhibition of mood-congruent
material. The negative-affective-priming task was
designed to assess inhibition in the processing of emo-
tional information ( Joormann, 2004). This task assesses
response times to positive and negative material that par-
ticipants are instructed to ignore. Dysphoric participants
and participants with a history of depressive episodes
exhibited reduced inhibition of negative material in their
performance on the negative-affective-priming task.
Thus, these participants responded faster when a nega-
tive target was presented after a to-be-ignored negative
distractor on the previous trial. As predicted, no group
difference was found for the positive adjectives. It is
important that these findings were replicated using a
negative-priming task with emotional faces (Goeleven,
DeRaedt, Baert, & Koster, 2006).
Negative-priming tasks assess only one aspect of inhi-
bition, that is, the ability to control the access of relevant
and irrelevant material to working memory. In addition,
there is an ongoing debate about the processes that
underlie negative priming (e.g., Neill, Valdes, & Terry,
1995). Whereas these studies have suggested that depres-
sion involves difficulties keeping irrelevant emotional
information from entering working memory, depression
may also be associated with difficulties removing previ-
ously relevant negative material from working memory
(i.e., updating). Difficulties inhibiting the processing of
negative material that was, but is no longer, relevant
might explain why people respond to negative mood
states and negative life events with recurring, uncontrol-
lable, and unintentional negative thoughts. This hypoth-
esis was tested with a modified Sternberg task that
combines a short-term recognition task with instructions
to ignore a previously memorized list of words to assess
inhibition of irrelevant positive and negative stimuli
( Joormann & Gotlib, 2008). Participants diagnosed with
major depression exhibited difficulties removing irrele-
vant negative material from working memory. Specifically,
compared with never-depressed control participants,
depressed individuals exhibited longer decision latencies
to an intrusion probe (i.e., a word from the irrelevant list)
than to a new probe (i.e., a completely new word),
thereby reflecting the strength of the residual activation
of the contents of working memory that were declared to
be no longer relevant. This pattern was not found for
positive material. Finally, when participants were asked
to re-sort material in working memory, diagnosed
depressed participants had difficulties manipulating neg-
ative material in working memory, and this deficit was
associated with self-reported proneness to rumination
( Joormann, Levens, & Gotlib, 2011).
Deficits in cognitive control not only may affect a
persons ability to discard irrelevant material from work-
ing memory, thereby increasing unwanted thoughts,
but also may make it difficult to intentionally forget
unwanted material. The idea that depression is associ-
ated with these control deficits has been tested in
directed-forgetting tasks in which participants are
instructed to forget previously studied material at some
point during the experiment. Later recall is tested, how-
ever, for material that was to be remembered and mate-
rial that was to be forgotten (Bjork & Whitten, 1974).
Using positive and negative words, Power, Dalgleish,
Claudio, Tata, and Kentish (2000) reported differential
directed-forgetting effects for depressed and nonde-
pressed participants. Specifically, the depressed partici-
pants exhibited a facilitation effect for negative words
after the instruction to forget. It is important to note that
the effect was found only when the adjectives were pro-
cessed in a self-relevant manner. Hertel and Gerstle (2003)
demonstrated that, compared with control participants,
dysphoric participants recalled more words they were
supposed to forget, with a tendency toward increased
recall of to-be-forgotten negative words. Moreover, the
degree of forgetting was significantly correlated with self-
report measures of rumination and unwanted thoughts.
As we have outlined, depression is characterized by
deficits in inhibition, updating of working memory, and
forgetting. These deficits have also been linked to the use
and effectiveness of ER in depression, particularly to an
increased tendency to ruminate (Whitmer & Gotlib,
2013). Davis and Nolen-Hoeksema (2000) reported that
ruminators made more errors on the Wisconsin Card
Sorting Test than did nonruminators. Because the
Wisconsin Card Sorting Test measures executive control
and cognitive flexibility, these results provide empirical
support for the hypothesis that rumination is related to
the executive-control component of working memory. In
addition, correlations between rumination and deficits in
cognitive inhibition have been reported ( Joormann, 2006;
Joormann & Gotlib, 2010). Difficulty removing negative
irrelevant words from working memory was highly cor-
related with self-reported rumination, as were difficulties
manipulating negative material in working memory
( Joormann etal., 2011). Finally, participants who scored
high on a trait measure of rumination exhibited reduced
forgetting of negative material in this task ( Joormann &
Tran, 2009).
Deficits in cognitive control may also make it diffi-
cult to employ attention flexibly, to override interpre-
tive biases, and to use adaptive ER strategies, such as
reappraisal. Unfortunately, few studies to date have
investigated whether individual differences in cogni-
tive inhibition affect peoples ability to use reappraisal.
One notable exception showed that, among healthy
Emotion Regulation in Depression 413
individuals, measures of general inhibition, as measured
by performance on the Stroop task, were not associated
with reappraisal ability (McRae etal., 2012). However,
it is plausible that although this study did not find a
link between general inhibition and reappraisal effec-
tiveness, deficits in inhibition of negative material are
associated with reappraisal. The latter possibility is
particularly compelling, given the association between
deficits in inhibition of negative stimuli with depression
as well as with rumination ( Joormann & Gotlib, 2010).
This relation, however, remains to be tested.
Although inhibition has not yet been linked to reap-
praisal, Malooly, Genet, and Siemer (2013) found that,
among healthy participants, better ability to shift atten-
tional sets (i.e., shifting ability) was associated with
greater downregulation of negative affect using reap-
praisal. The authors measured shifting ability using an
affective-switching task. In this task, individuals were
presented with an image and instructed to sort the image
according to an affective rule (i.e., sort by valence
happy vs. sad) or a nonaffective rule (i.e., sort by number
of peopleone or less vs. two or more). Switching was
measured by response times to sort the images when the
sorting rule switched, that is, the response time to sort an
image when the current rule is different from the sorting
rule on the previous trial. Malooly etal. found that greater
effectiveness of reappraisal during a sad film clip was
associated with better performance when switching to
the neutral aspects of negative images and when switch-
ing to the positive aspects of positive images. Whitmer
and Gotlib (2012) also found that depressed individuals
who completed a rumination induction exhibited poorer
switching ability than did depressed and nondepressed
individuals who completed a distraction induction and
healthy control individuals who completed a rumination
induction. Last, among depressed participants but not
healthy control individuals, rumination was associated
with reduced ability to update working memory (Meiran,
Diamond, Toder, & Nemets, 2011). More research that
investigates the relation of cognitive control (inhibition,
updating, and shifting) and ER in depression is needed.
However, early evidence from clinical and healthy sam-
ples has suggested that deficits in cognitive control are
associated with induced rumination and poorer reap-
praisal ability.
Studies recently have started to investigate the possi-
bility of training cognitive control in depression and the
effects of this training on ER. Depressed participants,
for example, could be trained to forget negative material
by practicing active suppression and did particularly
well when they were provided with a strategy of how to
keep irrelevant material from entering working memory
(i.e., by using thought substitutes; Joormann, Hertel,
LeMoult, & Gotlib, 2009). Unfortunately, this study did
not investigate whether suppression training affected
mood or emotional reactivity to a stressor. In a recent
study, Daches and Mor (2013) trained participants high in
trait rumination to inhibit negative stimuli. The results
from this preliminary study showed improved inhibition
but no effect on depression symptoms. Siegle, Thompson,
Carter, Steinhauer, and Thase (2007), however, presented
preliminary data that demonstrated that a brief interven-
tion targeted at increasing cognitive control in severely
depressed outpatients led to significant decreases in both
depressive symptoms and rumination. Indeed, work by
this group has suggested that training in attentional con-
trol may be an effective treatment component for depres-
sion (Siegle, Ghinassi, & Thase, 2007). In this training,
patients learn to selectively attend to certain sounds
while ignoring irrelevant sounds. After 2 weeks of train-
ing, patients exhibited decreases in depressive symptoms
compared with patients who received treatment as usual
(Siegle, Ghinassi, & Thase, 2007). It is notable that the
training consisted of short sessions (15 min) that used
nonaffective stimuli, such as the sound of birds. Similar
results were obtained in a recent study in which research-
ers examined cognitive-control training in individuals
with MDD and individuals with bipolar disorder and
found that this training led to reduced depressive symp-
toms (Preiss, Shatil, ermkov, Cimermanov, & Ram,
2013). This suggests that cognitive control can be
improved with practice and further supports the hypoth-
esis that individual differences in cognitive control may
affect ER.
To summarize, MDD has been shown to be associated
with biases in attention, interpretation, and memory that
affect the processing of negative and positive material. In
addition, deficits in cognitive control may interfere with
the ability to override biased attention and interpretation,
thereby resulting in more frequent use of maladaptive ER
strategies and impairments in the use of adaptive strate-
gies. More research is clearly needed, however, that
directly links cognitive biases and deficits in cognitive
control to ER and emotional responding under stress.
Summary and Future Directions
Given that sustained negative affect and difficulties expe-
riencing positive affect are the hallmark features of
depression, basic research on the regulation of affect pro-
vides important information for an improved understand-
ing of the etiology, maintenance, and treatment of this
debilitating disorder. Our review of the literature pro-
vides evidence for the importance of two aspects of ER:
individual differences in the habitual use of ER strategies
and difficulties in the implementation of adaptive strate-
gies. Specifically, MDD has been associated with frequent
use of rumination and less use of reappraisal. Furthermore,
414 Joormann, Vanderlind
preliminary evidence has shown that depression is asso-
ciated with difficulties upregulating and maintaining pos-
itive affect and attempts to dampen positive emotion.
Recent research also has suggested an association with
heightened emotion nonacceptance as well as fear of
high intensity affect. Results for other ER strategies were
either missing or inconsistent, so more work is needed to
further clarify the role of, for example, suppression and
distraction in MDD. It is important to note that the major-
ity of studies on habitual strategy use have been cross-
sectional and relied on self-report only. This is problematic
because it is not clear to what extent people can accu-
rately report on their use of strategies, and the self-report
of ER may be affected by current mood state. More stud-
ies on strategy use in response to a mood manipulation
(e.g., Ehring et al., 2010) or in an experience-sampling
design are clearly needed.
Fewer studies have been conducted to examine diffi-
culties in the implementation of adaptive strategies, and
this area clearly should be a focus of future research on
ER in this disorder. Initial findings have suggested
that whereas depressed participants can use distraction
effectively, reappraisal is more challenging. Studies have
suggested that depression is associated with difficulties
using positive material to offset negative affect. Whereas
some studies have suggested that these difficulties in
strategy implementation do not just characterize cur-
rently depressed participants, more research is needed
on the question whether we find similar deficits prior to
the first episode of the disorder and whether these diffi-
culties predict future episodes of MDD. Specifically, lon-
gitudinal studies in high-risk samples are needed to
answer the important question whether these difficulties
in ER are indeed a risk factor for the onset of the disorder
or simply an epiphenomenon.
Most studies on ER have focused on the downregula-
tion of negative affect, but our review of the literature
shows that the processing of mood-incongruent material
and the regulation of positive affect may also play an
important role in MDD. Our review of the literature
shows that difficulties enhancing positive affect and a
tendency to dampen positive emotions characterize
depression. In addition, recent studies have demonstrated
that depressed participants try to avoid not only intense
negative affect but also intense positive affect. In addi-
tion, studies on mood-incongruent recall have indicated
that even though depressed participants recall positive
memories, they have difficulties using these memories to
repair negative affect. Taken together, the downregula-
tion of negative affect seems a very narrow focus. Future
research should pay more attention to the regulation of
positive affect in depression. A focus on responses to
positive affect could also improve current depression
treatment. Indeed, in a recent intervention study,
McMakin, Siegle, and Shirk (2011) included a module on
enhancing and maintaining positive affect and found
greater improvements in depression symptoms.
We further examined cognitive processes that may
underlie difficulties in ER. Research on cognitive biases
and deficits that are associated with MDD may help to
better understand maladaptive ER and difficulties imple-
menting adaptive ER strategies. Indeed, biased cognition
in conjunction with deficits in cognitive control may
guide emotional responding in depression and explain
difficulties overriding maladaptive responding with the
use of more adaptive ER strategies (see Fig. 1). Biased
processing in depression may affect the initial appraisal
of an emotion-eliciting event and result in automatic mal-
adaptive responses (e.g., rumination). Cognitive-control
deficits may affect strategies such as distraction and reap-
praisal. Whereas both strategies require cognitive control,
reappraisal is frequently seen as the more effortful strat-
egy, which may explain why distraction works but reap-
praisal may fail in depressed participants. Timing over
the course of an emotional response may also be a key
variable that influences the effectiveness of reappraisal.
Reappraisal, initiated once an emotional response is
under way (often referred to as on-line reappraisal),
appears to be more difficult to implement and more cog-
nitively taxing than anticipatory reappraisal or other strat-
egies (e.g., distraction) implemented at early processing
stages of an emotional episode (Sheppes, Catran, &
Meiran, 2009; Sheppes & Meiran, 2007; Urry, 2009).
Indeed, recent work by Sheppes, Scheibe, Suri, and Gross
(2011) has shown that reappraisal becomes more difficult
if affect is intense and that nondisordered participants
prefer to use distraction over reappraisal when they deal
with intense emotions. In addition, Sheppes and Gross
(2011) have pointed out that engaging ER strategies at a
later point in the emotion episode typically results in the
regulation of more intense affect. Despite the increased
difficulty, on-line reappraisal may be particularly impor-
tant to examine in MDD. Given the persistent negative
affect characterizing this disorder, individuals with
depression likely need to implement ER strategies in
response to an existing emotional state of relatively high
intensity. If implemented on-line, reappraisal probably
requires levels of cognitive control that may not be avail-
able to people with affective disorders. This represents
an important area that needs further research.
Whereas this article focuses on the role of cognitive
processes and ER difficulties in depression, it is important
to keep in mind that many of the discussed constructs
probably cut across different disorders and are not spe-
cific to depression. As described in the previous sections,
for example, the use of maladaptive strategies, such as
rumination, has been shown to play a role in many inter-
nalizing and even some externalizing disorders. Ruscio,
Emotion Regulation in Depression 415
Seitchik, Gentes, Jones, and Hallion (2011), for example,
found that perseverative thought, a construct resembling
rumination, was not unique to depression but, rather,
characterized heightened emotional reactivity across
both MDD and generalized anxiety disorder. Whereas
much research has been done on the role of rumination
across disorders, more work needs to be done on other
ER strategies, such as reappraisal and suppression. In one
of the first studies to include internalizing and external-
izing disorders, Aldao et al. (2010) conducted a meta-
analysis in which they examined the habitual use of six
ER strategies across four psychopathology groups (anxi-
ety, depression, eating, and substance-use disorders).
The authors found that all psychopathologies were asso-
ciated with greater use of maladaptive ER strategies and
less use of adaptive ER strategies. Nevertheless, depres-
sion and anxiety were more strongly linked to increased
use of rumination and avoidance of emotion, as well as
decreased use of reappraisal, than were eating and
substance-use disorders. These results imply that ER dif-
ficulties may represent an underlying transdiagnostic
maintenance factor but that the role of these difficulties
may be more prominent in internalizing disorders, such
as depression and anxiety.
In this context, it also seems important to examine
more closely the relation of specific ER strategies to other
individual difference constructs, such as neuroticism,
impulsivity, and extraversion. A close link between these
constructs and the use of ER strategies could explain why
difficulties with ER can be viewed as a transdiagnostic
risk factor. Similarly, whereas there is some evidence of
specificity of cognitive biases, cognitive-control deficits
have been proposed as another important transdiagnos-
tic risk factor (for reviews, see Joormann et al., 2010;
Mathews & MacLeod, 2005). In sum, cognitive biases and
ER difficulties are present across many psychological dis-
orders. Nevertheless, there is some evidence that their
role is especially important in the conceptualization of
the etiology and maintenance of internalizing disorders,
such as MDD.
Finally, there are some important treatment implica-
tions that warrant discussion. Cognitive-behavioral ther-
apy has focused on the identification and modification of
maladaptive cognitions, and recent additions to this inter-
vention have started to focus more systematically on
training reappraisal skills and preventing emotional
avoidance (Campbell-Sills & Barlow, 2007). Given the
earlier discussion of cognitive processes that underlie ER,
recent studies on cognitive-bias modification and cogni-
tive-control training seem particularly promising. Most of
these studies have been conducted with samples com-
posed of patients with anxiety disorders, but at least two
recent studies have provided encouraging data that a
training aimed at modifying attention biases may also
apply to depression (Baert etal., 2011; Wells & Beevers,
2010). Other studies have focused on modifying memory
and interpretation biases, but these trainings have not yet
been tested with depressed participants (Raes, Williams,
& Hermans, 2009). Of special importance is a recent
study that showed improvement in cognitive control after
a training of executive control. Specifically, cognitive-
control training yielded transferable gains to improved
control over affective stimuli and ER (Schweizer, Grahn,
Hampshire, Mobbs, & Dalgleish, 2013; Schweizer,
Hampshire, & Dalgleish, 2011). A similar training showed
effects on thought control over intrusive memories
(Bomyea & Amir, 2011). Whereas cognitive-bias modifi-
cation provides a unique method to examine the causal
role of cognition in psychopathology and thereby repre-
sents an exciting area for potential intervention, future
research is needed to understand the mechanisms of
how bias modification is effective and moderators that
examine when it works.
This review showcases the enormous strides that
research on ER in psychological disorders has made over
the years. Nevertheless, there are important conceptual
and methodological questions that remain unanswered.
For example, research on habitual strategy use often
does not consider the situations in which individuals use
these strategies. Research has shown, however, that strat-
egy effectiveness can vary depending on the circum-
stances in which strategies are used. Webb etal. (2012)
reported, for example, that reappraisal of an emotion-
eliciting event was more effective at reducing negative
affect than was reappraisal of the emotion itself. Similarly,
Troy, Shallcross, and Mauss (2013) found that reappraisal
effectively regulated affect in responses to uncontrollable
stressors but appeared to be maladaptive in responses to
controllable stressors (i.e., when the situation can be
changed). Greater consideration of the contexts in which
people use different ER strategies is recommended for
future research that investigates ER in psychopathology.
A second limitation of the extant literature is the focus on
individual ER strategies rather than comprehensive ER
profiles. As highlighted earlier, Aldao and Nolen-
Hoeksema (2012) found that the relation between psy-
chopathology and ER strategy use can vary depending
on which other ER strategies are habitually used. Thus,
studying an ER strategy in isolation likely dilutes its effec-
tiveness and relation to psychopathology.
Consistent with this observation is Bonanno and
Burtons (2013) recent suggestion that successful ER likely
depends on the flexibility to adopt an ER strategy that
best fits a given situation. Very few studies on affective
disorders have assessed more than one strategy, and it is
currently not known whether the primary problem in ER
in these disorders is inflexibility instead of habitual use of
a specific strategy or difficulties implementing a strategy.
416 Joormann, Vanderlind
Therefore, understanding how ER strategies can work
together, rather than which one is most effective in isola-
tion, represents an important avenue for future research.
Author Contributions
J. Joormann and W. M. Vanderlind worked together on the
concept of the article. J. Joormann wrote a first draft and both
authors conducted literature searches. W. M. Vanderlind pro-
vided edits of the draft. All authors approved the final version.
Declaration of Conflicting Interests
The authors declared that they had no conflicts of interest
with respect to their authorship or the publication of this
article.
References
Aldao, A., & Nolen-Hoeksema, S. (2012). When are adaptive
strategies most predictive of psychopathology? Journal of
Abnormal Psychology, 121, 276281. doi:10.1037/a0023598
Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010).
Emotion-regulation strategies across psychopathology: A
meta-analytic review. Clinical Psychology Review, 30, 217
237. doi:10.1016/j.cpr.2009.11.004
American Psychiatric Association (2013). Diagnostic and statis-
tical manual of mental disorders (5th ed.). Arlington, VA:
American Psychiatric Publishing.
Baert, S., Koster, E. H. W., & De Raedt, R. (2011). Modification
of information processing biases in emotional disorders:
Clinically relevant developments in experimental psycho-
pathology. International Journal of Cognitive Therapy, 4,
208222. doi:10.1521/ijct.2011.4.2.208
Beard, C., & Amir, N. (2008). A multi-session interpretation
modification program: Changes in interpretation and social
anxiety symptoms. Behaviour Research and Therapy, 46,
11351141. doi:10.1016/j.brat.2008.05.012
Beblo, T., Fernando, S., Klocke, S., Griepenstroh, J.,
Aschenbrenner, S., & Driessen, M. (2012). Increased sup-
pression of negative and positive emotions in major
depression. Journal of Affective Disorders, 141, 474479.
doi:10.1016/j.jad.2012.03.019
Beck, A. T. (1967). Depression: Clinical, experimental, and the-
oretical aspects. New York, NY: Harper & Row.
Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979).
Cognitive therapy of depression: A treatment manual. New
York, NY: Guilford Press.
Beevers, C. G., & Carver, C. S. (2003). Attentional bias and
mood persistence as prospective predictors of dys-
phoria. Cognitive Therapy and Research, 27, 619637.
doi:10.1023/A:1026347610928
Bisson, M. A. S., & Sears, C. R. (2007). The effect of depressed
mood on the interpretation of ambiguity, with and without
negative mood induction. Cognition & Emotion, 21, 614
645. doi:10.1080/02699930600750715
Bjork, R. A., & Whitten, W. B. (1974). Recency-sensitive retrieval
processes in long-term free recall. Cognitive Psychology, 6,
173189. doi:10.1016/0010-0285(74)90009-7
Bomyea, J., & Amir, N. (2011). The effect of an executive func-
tioning training program on working memory capacity and
intrusive thoughts. Cognitive Therapy and Research, 35,
529535. doi:10.1007/s10608-011-9369-8
Bonanno, G. A., & Burton, C. L. (2013). Regulatory flexibility:
An individual differences perspective on coping and emo-
tion regulation. Perspectives on Psychological Science, 8,
591612. doi:10.1177/1745691613504116
Bradley, B. P., Mogg, K., & Lee, S. C. (1997). Attentional biases
for negative information in induced and naturally occurring
dysphoria. Behaviour Research and Therapy, 35, 911927.
doi:10.1016/S0005-7967(97)00053-3
Butler, G., & Mathews, A. (1983). Cognitive processes in anxi-
ety. Advances in Behaviour Research and Therapy, 5, 51
62. doi:10.1016/0146-6402(83)90015-2
Campbell-Sills, L., & Barlow, D. H. (2007). Incorporating emo-
tion regulation into conceptualizations and treatments of
anxiety and mood disorders. In J. J. Gross (Ed.), Handbook
of emotion regulation (pp. 542559). New York, NY:
Guilford Press.
Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S.
G. (2006). Acceptability and suppression of negative emo-
tion in anxiety and mood disorders. Emotion, 6, 587595.
doi:10.1037/1528-3542.6.4.587
Caseras, X., Garner, M., Bradley, B. P., & Mogg, K. (2007).
Biases in visual orienting to negative and positive
scenes in dysphoria: An eye movement study. Journal of
Abnormal Psychology, 116, 491497. doi:10.1037/0021-
843X.116.3.491
Charles, S. T., Mather, M., & Carstensen, L. L. (2003). Aging
and emotional memory: The forgettable nature of negative
images for older adults. Journal of Experimental Psychology:
General, 132, 310324. doi:10.1037/0096-3445.132.2.310
Clasen, P. C., Wells, T. T., Ellis, A. J., & Beevers, C. G. (2013).
Attentional biases and the persistence of sad mood in major
depressive disorder. Journal of Abnormal Psychology, 122,
7485. doi:10.1037/a0029211
Compton, R. J., Heller, W., Banich, M. T., Palmieri, P. A., & Miller,
G. A. (2000). Responding to threat: Hemispheric asymmetries
and interhemispheric division of input. Neuropsychology,
14, 254264. doi:10.1037/0894-4105.14.2.254
Cowan, N. (1999). An embedded-processes model of working
memory. In A. Miyake & P. Shah (Eds.), Models of working
memory: Mechanisms of active maintenance and executive
control (pp. 62101). New York, NY: Cambridge University
Press.
Cowden Hindash, A. H., & Amir, N. (2012). Negative inter-
pretation bias in individuals with depressive symptoms.
Cognitive Therapy and Research, 36, 502511. doi:10.1007/
s10608-011-9397-4
Daches, S., & Mor, N. (2013). Training ruminators to inhibit
negative information: A preliminary report. Cognitive
Therapy and Research, 38, 160171. doi:10.1007/s10608-
013-9585-5
Dalgleish, T., Spinks, H., Yiend, J., & Kuyken, W. (2001).
Autobiographical memory style in seasonal affective
disorder and its relationship to future symptom remis-
sion. Journal of Abnormal Psychology, 110, 335340.
doi:10.1037/0021-843X.110.2.335
Emotion Regulation in Depression 417
DAvanzato, C., Joormann, J., Siemer, M., & Gotlib, I. H. (2013).
Emotion regulation in depression and anxiety: Examining
diagnostic specificity and stability. Cognitive Therapy and
Research, 37, 968980. doi:10.1007/s10608-013-9537-0
Davis, R. N., & Nolen-Hoeksema, S. (2000). Cognitive inflexibil-
ity among ruminators and nonruminators. Cognitive Therapy
and Research, 24, 699711. doi:10.1023/A:1005591412406
Dearing, K. F., & Gotlib, I. H. (2009). Interpretation of ambig-
uous information in girls at risk for depression. Journal
of Abnormal Child Psychology, 37, 7991. doi:10.1007/
s10802-008-9259-z
Demenescu, L. R., Renken, R., Kortekaas, R., van Tol, M.-J.,
Marsman, J. B. C., van Buchem, M. A., . . . Aleman, A.
(2011). Neural correlates of perception of emotional facial
expression in out-patients with mild-to-moderate depres-
sion and anxiety: A multicenter fMRI study. Psychological
Medicine, 41, 22532264. doi:10.1017/S0033291711000596
Dillon, D., & Pizzagalli, D. (2013). Evidence of successful mod-
ulation of brain activation and subjective experience during
reappraisal of negative emotion in unmedicated depres-
sion. Psychiatry Research: Neuroimaging, 212, 99107.
doi:10.1016/j.pscychresns.2013.01.001
Donaldson, C., Lam, D., & Mathews, A. (2007). Rumination and
attention in major depression. Behaviour Research and
Therapy, 45, 26642678. doi:10.1016/j.brat.2007.07.002
Drabant, E. M., McRae, K., Manuck, S. B., Hariri, A. R., & Gross,
J. J. (2009). Individual differences in typical reappraisal
use predict amygdala and prefrontal responses. Biological
Psychiatry, 65, 367373. doi:10.1016/j.biopsych.2008.09.007
Ehring, T., Tuschen-Caffier, B., Schnlle, J., Fischer, S., &
Gross, J. J. (2010). Emotion regulation and vulnerability
to depression: Spontaneous versus instructed use of emo-
tion suppression and reappraisal. Emotion, 10, 563572.
doi:10.1037/a0019010
Eizenman, M., Yu, L. H., Grupp, L., Eizenman, E., Ellenbogen,
M., Gemar, M., & Levitan, R. D. (2003). A naturalistic visual
scanning approach to assess selective attention in major
depressive disorder. Psychiatry Research, 118, 117128.
doi:10.1016/S0165-1781(03)00068-4
Ellenbogen, M. A., Schwartzman, A. E., Stewart, J., & Walker,
C. (2002). Stress and selective attention: The interplay of
mood, cortisol levels, and emotional information process-
ing. Psychophysiology, 39, 723732. doi:10.1111/1469-8986
.3960723
Ellis, A. J., Vanderlind, W. M., & Beevers, C. G. (2012). Enhanced
anger reactivity and reduced distress tolerance in major
depressive disorder. Cognitive Therapy and Research, 37,
498509. doi:10.1007/s106080129494z
Friedman, N. P., & Miyake, A. (2004). The relations among inhi-
bition and interference control functions: A latent-variable
analysis. Journal of Experimental Psychology: General, 133,
101135. doi:10.1037/0096-3445.133.1.101
Garnefski, N., & Kraaij, V. (2006). Cognitive Emotion Regulation
Questionnaire: Development of a short 18-item version
(CERQ-Short). Personality and Individual Differences, 41,
10451053. doi:10.1016/j.paid.2006.04.010
Garnefski, N., Legerstee, J., Kraaij, V., van den Kommer, T., &
Teerds, J. (2002). Cognitive coping strategies and symp-
toms of depression and anxiety: A comparison between
adolescents and adults. Journal of Adolescence, 25, 603
611. doi:10.1006/jado.2002.0507
Goeleven, E., De Raedt, R., Baert, S., & Koster, E. H. W. (2006).
Deficient inhibition of emotional information in depression.
Journal of Affective Disorders, 93, 149157. doi:10.1016/
j.jad.2006.03.007
Gross, J. J. (1998). Antecedent- and response-focused emotion
regulation: Divergent consequences for experience, expres-
sion, and physiology. Journal of Personality and Social
Psychology, 74, 224237. doi:10.1037/0022-3514.74.1.224
Gross, J. J. (2014). Emotion regulation: Conceptual and empiri-
cal foundations. In J. J. Gross (Ed.), Handbook of emotion
regulation (2nd ed., pp. 320). New York, NY: Guilford
Press.
Gross, J. J., & John, O. P. (2003). Individual differences in two
emotion regulation processes: Implications for affect, rela-
tionships, and well-being. Journal of Personality and Social
Psychology, 85, 348362. doi:10.1037/0022-3514.85.2.348
Hasher, L., Zacks, R. T., & May, C. P. (1999). Inhibitory con-
trol, circadian arousal, and age. In D. Gopher & A. Koriat
(Eds.), Attention and performance XVII: Cognitive regula-
tion of performance: Interaction of theory and application
(pp. 653675). Cambridge, MA: MIT Press.
Heller, A. S., Johnstone, T., Shackman, A. J., Light, S. N., Peterson,
M. J., Kolden, G. G., . . . Davidson, R. J. (2009). Reduced
capacity to sustain positive emotion in major depression
reflects diminished maintenance of fronto-striatal brain acti-
vation. Proceedings of the National Academy of Sciences,
USA, 106, 2244522450. doi:10.1073/pnas.0910651106
Hertel, P. T. (1997). On the contributions of deficient cognitive
control to memory impairments in depression. Cognition &
Emotion, 11, 569583. doi:10.1080/026999397379890a
Hertel, P. (2004). Memory for emotional and nonemotional
events in depression: A question of habit? In D. Reisberg &
P. Hertel (Eds.), Memory and emotion (pp. 186216). New
York, NY: Oxford University Press.
Hertel, P. T., & Gerstle, M. (2003). Depressive deficits
in forgetting. Psychological Science, 14, 573578.
doi:10.1046/j.0956-7976.2003.psci_1467.x
John, O. P., & Gross, J. J. (2004). Healthy and unhealthy emo-
tion regulation: Personality processes, individual differ-
ences, and life span development. Journal of Personality,
72, 13011333. doi:10.1111/j.1467-6494.2004.00298.x
Johnson, D. R. (2009). Emotional attention set-shifting and its
relationship to anxiety and emotion regulation. Emotion, 9,
681690. doi:10.1037/a0017095
Johnstone, T., van Reekum, C. M., Urry, H. L., Kalin, N. H., &
Davidson, R. J. (2007). Failure to regulate: Counterproductive
recruitment of top-down prefrontal-subcortical circuitry in
major depression. Journal of Neuroscience, 27, 88778884.
doi:10.1523/JNEUROSCI.2063-07.2007
Joormann, J. (2004). Attentional bias in dysphoria: The role of
inhibitory processes. Cognition & Emotion, 18, 125147.
doi:10.1080/02699930244000480
Joormann, J. (2005). Inhibition, rumination, and mood regu-
lation in depression. In R. W. Engle, G. Sedek, U. von
Hecker, & D. N. McIntosh (Eds.), Cognitive limitations in
aging and psychopathology (pp. 275312). New York, NY:
Cambridge University Press.
418 Joormann, Vanderlind
Joormann, J. (2006). Differential effects of rumination and dys-
phoria on the inhibition of irrelevant emotional material:
Evidence from a negative priming task. Cognitive Therapy
and Research, 30, 149160. doi:10.1007/s10608-006-9035-8
Joormann, J. (2010). Cognitive inhibition and emotion regu-
lation in depression. Current Directions in Psychological
Science, 19, 161166. doi:10.1177/0963721410370293
Joormann, J., Cooney, R. E., Henry, M. L., & Gotlib, I. H. (2012).
Neural correlates of automatic mood regulation in girls at
high risk for depression. Journal of Abnormal Psychology,
121, 6172. doi:10.1037/a0025294
Joormann, J., & Gotlib, I. H. (2007). Selective attention to emo-
tional faces following recovery from depression. Journal
of Abnormal Psychology, 116, 8085. doi:10.1037/0021-
843X.116.1.80
Joormann, J., & Gotlib, I. H. (2008). Updating the contents of
working memory in depression: Interference from irrel-
evant negative material. Journal of Abnormal Psychology,
117, 182192. doi:10.1037/0021-843X.117.1.182
Joormann, J., & Gotlib, I. H. (2010). Emotion regulation in
depression: Relation to cognitive inhibition. Cognition &
Emotion, 24, 281298. doi:10.1080/02699930903407948
Joormann, J., Hertel, P. T., LeMoult, J., & Gotlib, I. H. (2009).
Training forgetting of negative material in depression.
Journal of Abnormal Psychology, 118, 3443. doi:10.1037/
a0013794
Joormann, J., Levens, S., & Gotlib, I. H. (2011). Sticky
thoughts: Depression and rumination are associated
with difficulties manipulating emotional material in
working memory. Psychological Science, 22, 979983.
doi:10.1177/0956797611415539
Joormann, J., & Siemer, M. (2004). Memory accessibility,
mood regulation, and dysphoria: Difficulties in repairing
sad mood with happy memories? Journal of Abnormal
Psychology, 113, 179188. doi:10.1037/0021-843X.113.2.179
Joormann, J., & Siemer, M. (2014). Emotion regulation in mood
disorders. In J. J. Gross (Ed.), Handbook of emotion regula-
tion (2nd ed., pp. 320). New York, NY: Guilford Press.
Joormann, J., Siemer, M., & Gotlib, I. H. (2007). Mood regulation
in depression: Differential effects of distraction and recall
of happy memories on sad mood. Journal of Abnormal
Psychology, 116, 484490. doi:10.1037/0021-843X.116.3.484
Joormann, J., Talbot, L., & Gotlib, I. H. (2007). Biased pro-
cessing of emotional information in girls at risk for depres-
sion. Journal of Abnormal Psychology, 116, 135143.
doi:10.1037/0021-843X.116.1.135
Joormann, J., & Tran, T. (2009). Rumination and intentional
forgetting of emotional material. Cognition & Emotion, 23,
12331246. doi:10.1080/02699930802416735
Joormann, J., Yoon, K., & Siemer, M. (2010). Cognition and
emotion regulation. In A. M. Kring & D. M. Sloan (Eds.),
Emotion regulation and psychopathology: A transdiagnos-
tic approach to etiology and treatment (pp. 174203). New
York, NY: Guilford Press.
Kanske, P., Heissler, J., Schnfelder, S., & Wessa, M. (2012).
Neural correlates of emotion regulation deficits in remitted
depression: The influence of regulation strategy, habitual
regulation use, and emotional valence. NeuroImage, 61,
686693. doi:10.1016/j.neuroimage.2012.03.089
Kellough, J. L., Beevers, C. G., Ellis, A. J., & Wells, T. T. (2008).
Time course of selective attention in clinically depressed
young adults: An eye-tracking study. Behaviour Research
and Therapy, 46, 12381243. doi:10.1016/j.brat.2008.07.004
Kessler, R. C., & Wang, P. S. (2009). Epidemiology of depres-
sion. In I. H. Gotlib & C. L. Hammen (Eds.), Handbook of
depression (2nd ed., pp. 522). New York, NY: Guilford
Press.
Koster, E. W., De Lissnyder, E., Derakshan, N., & De Raedt,
R. (2011). Understanding depressive rumination from a
cognitive science perspective: The impaired disengage-
ment hypothesis. Clinical Psychology Review, 31, 138145.
doi:10.1016/j.cpr.2010.08.005
Koster, E. H. W., De Raedt, R., Goeleven, E., Franck, E., &
Crombez, G. (2005). Mood-congruent attentional bias in
dysphoria: Maintained attention to and impaired disen-
gagement from negative information. Emotion, 5, 446455.
doi:10.1037/1528-3542.5.4.446
Larsen, J. K., Vermulst, A. A., Geenen, R., van Middendorp, H.,
English, T., Gross, J. J., . . . Engels, R. C. M. E. (2013). Emotion
regulation in adolescence: A prospective study of expres-
sive suppression and depressive symptoms. Journal of Early
Adolescence, 33, 184200. doi:10.1177/0272431611432712
Lawson, C., & MacLeod, C. (1999). Depression and the interpre-
tation of ambiguity. Behaviour Research and Therapy, 37,
463474. doi:10.1016/S0005-7967(98)00131-4
Lawson, C., MacLeod, C., & Hammond, G. (2002). Interpretation
revealed in the blink of an eye: Depressive bias in the reso-
lution of ambiguity. Journal of Abnormal Psychology, 111,
321328. doi:10.1037/0021-843X.111.2.321
Lazarus, R. S. (1966). Psychological stress and the coping
process. New York, NY: McGraw-Hill.
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and cop-
ing. New York, NY: Springer.
Lim, S., & Kim, J. (2005). Cognitive processing of emotional
information in depression, panic, and somatoform
disorder. Journal of Abnormal Psychology, 114, 5061.
doi:10.1037/0021-843X.114.1.50
Liverant, G. I., Brown, T. A., Barlow, D. H., & Roemer, L.
(2008). Emotion regulation in unipolar depression: The
effects of acceptance and suppression of subjective emo-
tional experience on the intensity and duration of sadness
and negative affect. Behaviour Research and Therapy, 46,
12011209. doi:10.1016/j.brat.2008.08.001
Liverant, G. I., Kamholz, B. W., Sloan, D. M., & Brown, T. A.
(2011). Rumination in clinical depression: A type of emo-
tional suppression? Cognitive Therapy and Research, 35,
253265. doi:10.1007/s10608-010-9304-4
Lyubomirsky, S., & Nolen-Hoeksema, S. (1993). Self-perpetuating
properties of dysphoric rumination. Journal of Personality
and Social Psychology, 65, 339349. doi:10.1037/0022-3514
.65.2.339
Lyubomirsky, S., & Nolen-Hoeksema, S. (1995). Effects of self-
focused rumination on negative thinking and interper-
sonal problem solving. Journal of Personality and Social
Psychology, 69, 176190. doi:10.1037/0022-3514.69.1.176
Mackintosh, B., Mathews, A., Yiend, J., Ridgeway, V., & Cook,
E. (2006). Induced biases in emotional interpretation influ-
ence stress vulnerability and endure despite changes in
Emotion Regulation in Depression 419
context. Behavior Therapy, 37, 209222. doi:10.1016/
j.beth.2006.03.001
MacLeod, C., Rutherford, E., Campbell, L., Ebsworthy, G.,
& Holker, L. (2002). Selective attention and emotional
vulnerability: Assessing the causal basis of their associa-
tion through the experimental manipulation of attentional
bias. Journal of Abnormal Psychology, 111, 107123.
doi:0.1037/0021-843X.111.1.107
Malooly, A. M., Genet, J. J., & Siemer, M. (2013). Individual dif-
ferences in reappraisal effectiveness: The role of affective
flexibility. Emotion, 13, 302313. doi:10.1037/a0029980
Mathews, A., & Mackintosh, B. (2000). Induced emotional inter-
pretation bias and anxiety. Journal of Abnormal Psychology,
109, 602615. doi:10.1037/0021-843X.109.4.602
Mathews, A., & MacLeod, C. (2005). Cognitive vulnerability to
emotional disorders. Annual Review of Clinical Psychology,
1, 167195. doi:10.1146/annurev.clinpsy.1.102803.143916
Matt, G. E., Vazquez, C., & Campbell, W. K. (1992). Mood-
congruent recall of affectively toned stimuli: A meta-
analytic review. Clinical Psychology Review, 12, 227255.
doi:10.1016/0272-7358(92)90116-P
McEvoy, P. M., Watson, H., Watkins, E. R., & Nathan, P. (2013).
The relationship between worry, rumination, and comor-
bidity: Evidence for repetitive negative thinking as a trans-
diagnostic construct. Journal of Affective Disorders, 151,
313320. doi:10.1016/j.jad.2013.06.014
McMakin, D. L., Siegle, G. J., & Shirk, S. R. (2011). Positive
affect stimulation and sustainment (PASS) module for
depressed mood: A preliminary investigation of treatment-
related effects. Cognitive Therapy and Research, 35, 217
226. doi:10.1007/s10608-010-9311-5
McRae, K., Jacobs, S. E., Ray, R. D., John, O. P., & Gross, J. J.
(2012). Individual differences in reappraisal ability: Links
to reappraisal frequency, well-being, and cognitive control.
Journal of Research in Personality, 46, 27. doi:10.1016/j
.jrp.2011.10.003
Meiran, N., Diamond, G. M., Toder, D., & Nemets, B. (2011).
Cognitive rigidity in unipolar depression and obses-
sive compulsive disorder: Examination of task switch-
ing, Stroop, working memory updating and post-conflict
adaption. Psychiatry Research, 185, 149156. doi:10.1016/
j.psychres.2010.04.044
Miyake, A., & Friedman, N. P. (2012). The nature and organiza-
tion of individual differences in executive functions: Four
general conclusions. Current Directions in Psychological
Science, 21, 814. doi:10.1177/0963721411429458
Miyake, A., & Shah, P. (1999). Models of working memory:
Mechanisms of active maintenance and executive control.
New York, NY: Cambridge University Press.
Mogg, K., Bradley, B. P., Williams, R., & Mathews, A. (1993).
Subliminal processing of emotional information in anxi-
ety and depression. Journal of Abnormal Psychology, 102,
304311. doi:10.1037/0021-843X.102.2.304
Mogoae, C., Brilean, A., & David, D. (2013). Can concreteness
training alone reduce depressive symptoms? A randomized
pilot study using an Internet-delivered protocol. Cognitive
Therapy and Research, 37, 704712. doi:10.1007/s10608-
012-9514-z
Neill, W., Valdes, L. A., & Terry, K. M. (1995). Selective attention
and the inhibitory control of cognition. In F. N. Dempster &
C. J. Brainerd (Eds.), Interference and inhibition in cogni-
tion (pp. 207261). San Diego, CA: Academic Press.
Nolen-Hoeksema, S. (1991). Responses to depression and their
effects on the duration of depressive episodes. Journal of
Abnormal Psychology, 100, 569582. doi:10.1037/0021-
843X.100.4.569
Nolen-Hoeksema, S. (2000). Further evidence for the role of
psychosocial factors in depression chronicity. Clinical
Psychology: Science and Practice, 7, 224227. doi:10.1093/
clipsy/7.2.224
Nolen-Hoeksema, S., Stice, E., Wade, E., & Bohon, C. (2007).
Reciprocal relations between rumination and bulimic, sub-
stance abuse, and depressive symptoms in female ado-
lescents. Journal of Abnormal Psychology, 116, 198207.
doi:10.1037/0021-843X.116.1.198
Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008).
Rethinking rumination. Perspectives on Psychological
Science, 3, 400424. doi:10.1111/j.1745-6924.2008.00088.x
Olatunji, B. O., Naragon-Gainey, K., & Wolitzky-Taylor, K. B.
(2013). Specificity of rumination in anxiety and depression:
A multimodal meta-analysis. Clinical Psychology: Science
and Practice, 20, 225257. doi:10.1111/cpsp.12037
Papageorgiou, C., & Wells, A. (2001). Positive beliefs about
depressive rumination: Development and preliminary vali-
dation of a self-report scale. Behavior Therapy, 32, 1326.
doi:10.1016/S0005-7894(01)80041-1
Power, M. J., Dalgleish, T., Claudio, V., Tata, P., & Kentish, J.
(2000). The directed forgetting task: Application to emo-
tionally valent material. Journal of Affective Disorders, 57,
147157. doi:10.1016/S0165-0327(99)00084-1
Preiss, M., Shatil, E., ermkov, R., Cimermanov, D., & Ram,
I. (2013). Personalized cognitive training in unipolar and
bipolar disorder: A study of cognitive functioning. Frontiers
in Human Neuroscience, 7(108). Retrieved from http://
www.ncbi.nlm.nih.gov/pmc/articles/PMC3651957/
Raes, F., Smets, J., Nelis, S., & Schoofs, H. (2012). Dampening
of positive affect prospectively predicts depressive symp-
toms in non-clinical samples. Cognition & Emotion, 26,
7582. doi:10.1080/02699931.2011.555474
Raes, F., Williams, J. M. G., & Hermans, D. (2009). Reducing
cognitive vulnerability to depression: A preliminary
investigation of memory specificity training (MEST) in
inpatients with depressive symptomatology. Journal of
Behavior Therapy and Experimental Psychiatry, 40, 2438.
doi:10.1016/j.jbtep.2008.03.001
Ray, R. D., McRae, K., Ochsner, K. N., & Gross, J. J. (2010).
Cognitive reappraisal of negative affect: Converging evi-
dence from EMG and self-report. Emotion, 10, 587592.
doi:10.1037/a0019015
Richards, J. M., & Gross, J. J. (2000). Emotion regulation
and memory: The cognitive costs of keeping ones cool.
Journal of Personality and Social Psychology, 79, 410424.
doi:10.1037/0022-3514.79.3.410
Rinck, M., & Becker, E. S. (2005). A comparison of attentional
biases and memory biases in women with social phobia
and major depression. Journal of Abnormal Psychology,
114, 6274. doi:10.1037/0021-843X.114.1.62
Ruscio, A. M., Seitchik, A. E., Gentes, E. L., Jones, J. D., & Hallion,
L. S. (2011). Perseverative thought: A robust predictor
of response to emotional challenge in generalized anxiety
420 Joormann, Vanderlind
disorder and major depressive disorder. Behaviour Research
and Therapy, 49, 867874. doi:10.1016/j.brat.2011.10.001
Rusting, C. L., & DeHart, T. (2000). Retrieving positive memo-
ries to regulate negative mood: Consequences for mood-
congruent memory. Journal of Personality and Social
Psychology, 78, 737752. doi:10.1037/0022-3514.78.4.737
Sanchez, A., Vazquez, C., Marker, C., LeMoult, J., & Joormann,
J. (2013). Disengagement predicts stress recovery in
depression: An eye-tracking study. Journal of Abnormal
Psychology, 122, 303313. doi:10.1037/a0031529
Schweizer, S., Grahn, J., Hampshire, A., Mobbs, D., & Dalgleish,
T. (2013). Training the emotional brain: Improving affec-
tive control through emotional working memory train-
ing. Journal of Neuroscience, 33, 53015311. doi:10.1523/
JNEUROSCI.2593-12.2013
Schweizer, S., Hampshire, A., & Dalgleish, T. (2011). Extending
brain-training to the affective domain: Increasing cog-
nitive and affective executive control through emo-
tional working memory training. PLoS ONE, 6(9),
e24372. Retrieved from http://www.plosone.org/article/
info%3Adoi%2F10.1371%2Fjournal.pone.0024372
Sears, C. R., Newman, K. R., Ference, J. D., & Thomas, C.
L. (2011). Attention to emotional images in previously
depressed individuals: An eye-tracking study. Cognitive
Therapy and Research, 35, 517528. doi:10.1007/s10608-
011-9396-5
Sheline, Y. I., Barch, D. M., Donnelly, J. M., Ollinger, J. M.,
Snyder, A. Z., & Mintun, M. A. (2001). Increased amygdala
response to masked emotional faces in depressed subjects
resolves with antidepressant treatment: An fMRI study.
Biological Psychiatry, 50, 651658. doi:10.1016/S0006-
3223(01)01263-X
Sheppes, G., Catran, E., & Meiran, N. (2009). Reappraisal (but
not distraction) is going to make you sweat: Physiological
evidence for self-control effort. International Journal
of Psychophysiology, 71, 9196. doi:10.1016/j.ijpsycho
.2008.06.006
Sheppes, G., & Gross, J. J. (2011). Is timing everything?
Temporal considerations in emotion regulation.
Personality and Social Psychology Review, 15, 319331.
doi:10.1177/1088868310395778
Sheppes, G., & Meiran, N. (2007). Better late than never? On the
dynamics of online regulation of sadness using distraction
and cognitive reappraisal. Personality and Social Psychology
Bulletin, 33, 15181532. doi:10.1177/0146167207305537
Sheppes, G., Scheibe, S., Suri, G., & Gross, J. J. (2011). Emotion-
regulation choice. Psychological Science, 22, 13911396.
doi:10.1177/0956797611418350
Siegle, G. J., Ghinassi, F., & Thase, M. E. (2007). Neurobehavioral
therapies in the 21st century: Summary of an emerging field
and an extended example of cognitive control training for
depression. Cognitive Therapy and Research, 31, 235262.
doi:10.1007/s10608-006-9118-6
Siegle, G. J., Thompson, W., Carter, C. S., Steinhauer, S. R., &
Thase, M. E. (2007). Increased amygdala and decreased dor-
solateral prefrontal BOLD responses in unipolar depression:
Related and independent features. Biological Psychiatry,
61, 198209. doi:10.1016/j.biopsych.2006.05.048
Siemer, M. (2005). Mood-congruent cognitions constitute mood
experience. Emotion, 5, 296308. doi:10.1037/1528-3542
.5.3.296
Siemer, M., & Reisenzein, R. (2007). The process of emotion
inference. Emotion, 7, 120. doi:10.1037/1528-3542.7.1.1
Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). State-
Trait Anxiety Inventory: STAI. Palo Alto, CA: Consulting
Psychologists Press.
Stewart, J. G., Mazurka, R., Bond, L., Wynne-Edwards, K. E., &
Harkness, K. L. (2013). Rumination and impaired cortisol
recovery following a social stressor in adolescent depres-
sion. Journal of Abnormal Child Psychology, 41, 10151026.
doi:10.1007/s10802-013-9740-1
Teachman, B., Joormann, J., Steinman, S. A., & Gotlib, I. H.
(2012). Automaticity in anxiety and depression.
Clinical Psychology Review, 32, 575603. doi:10.1016/
j.cpr.2012.06.004
Teasdale, J. D. (1988). Cognitive vulnerability to persis-
tent depression. Cognition & Emotion, 2, 247274.
doi:10.1080/02699938808410927
Thomas, E. J., Elliot, R., McKie, S., Arnone, D., Downey, D.,
Juhasz, G., . . . Anderson, I. M. (2011). Interaction between
a history of depression and rumination on neural response
to emotional faces. Psychological Medicine, 41, 18451855.
doi:10.1017/S0033291711000043
Troy, A. S., Shallcross, A. J., & Mauss, I. B. (2013). A per-
son-by-situation approach to emotion regulation:
Cognitive reappraisal can either help or hurt, depend-
ing on the context. Psychological Science, 24, 25052514.
doi:10.1177/0956797613496434
Troy, A. S., Wilhelm, F. H., Shallcross, A. J., & Mauss, I. B.
(2010). Seeing the silver lining: Cognitive reappraisal ability
moderates the relationship between stress and depressive
symptoms. Emotion, 10, 783795. doi:10.1037/a0020262
Urry, H. L. (2009). Using reappraisal to regulate unpleasant
emotional episodes: Goals and timing matter. Emotion, 9,
782797. doi:10.1037/a0017109
Wadlinger, H. A., & Isaacowitz, D. M. (2008). Looking happy:
The experimental manipulation of a positive visual
attention bias. Emotion, 8, 121126. doi:10.1037/1528-
3542.8.1.121
Walker, W. R., Skowronski, J. J., Gibbons, J. A., Vogl, R. J.,
& Thompson, C. P. (2003). On the emotions that accom-
pany autobiographical memories: Dysphoria disrupts the
fading affect bias. Cognition & Emotion, 17, 703723.
doi:10.1080/02699930302287
Watkins, E. R., Baeyens, C. B., & Read, R. (2009). Concreteness
training reduces dysphoria: Proof-of-principle for repeated
cognitive bias modification in depression. Journal of
Abnormal Psychology, 118, 5564. doi:10.1037/a0013642
Watkins, E., & Moulds, M. (2005). Distinct modes of ruminative
self-focus: Impact of abstract versus concrete rumination
on problem solving in depression. Emotion, 5, 319328.
doi:10.1037/1528-3542.5.3.319
Watkins, E., & Teasdale, J. D. (2001). Rumination and over-
general memory in depression: Effects of self-focus and
analytic thinking. Journal of Abnormal Psychology, 110,
353357. doi:10.1037/0021-843X.110.2.333
Emotion Regulation in Depression 421
Watkins, E., & Teasdale, J. D. (2004). Adaptive and maladaptive
self-focus in depression. Journal of Affective Disorders, 82,
18. doi:10.1016/j.jad.2003.10.006
Watkins, E., Teasdale, J. D., & Williams, R. M. (2000).
Decentering and distraction reduce overgeneral autobio-
graphical memory in depression. Psychological Medicine,
30, 911920. doi:10.1017/S0033291799002263
Webb, T. L., Miles, E., & Sheeran, P. (2012). Dealing with
feeling: A meta-analysis of the effectiveness of strategies
derived from the process model of emotion regulation.
Psychological Bulletin, 138, 775808. doi:10.1037/a0027600
Wells, T. T., & Beevers, C. G. (2010). Biased attention and
dysphoria: Manipulating selective attention reduces sub-
sequent depressive symptoms. Cognition & Emotion, 24,
719728. doi:10.1080/02699930802652388
Werner-Seidler, A., Banks, R., Dunn, B. D., & Moulds, M. L.
(2013). An investigation of the relationship between posi-
tive affect regulation and depression. Behaviour Research
and Therapy, 51, 4656. doi:10.1016/j.brat.2012.11.001
Werner-Seidler, A., & Moulds, M. L. (2012). Mood repair and
processing mode in depression. Emotion, 12, 470478.
doi:10.1037/a0025984
Whitmer, A. J., & Gotlib, I. H. (2012). Switching and back-
ward inhibition in major depressive disorder: The role of
rumination. Journal of Abnormal Psychology, 121, 570578.
doi:10.1037/a0027474
Whitmer, A. J., & Gotlib, I. H. (2013). An attentional scope
model of rumination. Psychological Bulletin, 139, 1036
1061. doi:10.1037/a0030923
Williams, A. D., Blackwell, S. E., Mackenzie, A., Holmes,
E. A., & Andrews, G. (2013). Combining imagination
and reason in the treatment of depression: A random-
ized controlled trial of Internet-based cognitive-bias
modification and Internet-CBT for depression. Journal
of Consulting and Clinical Psychology, 81, 793799.
doi:10.1037/a0033247
Williams, J. M. G., Barnhofer, T., Crane, C., Herman, D., Raes,
F., Watkins, E., & Dalgleish, T. (2007). Autobiographical
memory specificity and emotional disorder. Psychological
Bulletin, 133, 122148. doi:10.1037/0033-2909.133.1.122
Wilson, E. J., MacLeod, C., Mathews, A., & Rutherford, E. M.
(2006). The causal role of interpretative bias in anxiety
reactivity. Journal of Abnormal Psychology, 115, 103111.
doi:10.1037/0021-843X.115.1.103
Yiend, J., Mackintosh, B., & Mathews, A. (2005). Enduring
consequences of experimentally induced biases in inter-
pretation. Behaviour Research and Therapy, 43, 779797.
doi:10.1016/j.brat.2004.06.007